MEDICARE: MRS. MARY ANN GASIOR P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070004339	IL
2	222Q00000X	Developmental Therapist		IL

General Provider Information

NPI Number	:	1831248343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANN GASIOR P.T.

Provider Business Mailing Address
First Line	:	81 NORFOLK AVE
Second Line	:
City	:	CLARENDON HILLS
State	:	IL
Zip	:	60514-1242
Country	:	US
Telephone Number	:	773-909-1185
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 NORFOLK AVE
Second Line	:
City	:	CLARENDON HILLS
State	:	IL
Zip	:	60514-1242
Country	:	US
Telephone Number	:	773-909-1185
Fax Number	:	630-522-4759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	10/02/2015

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